lA    STATE     BOARD    OF    HEALTH 


B    3   7 TTDS5 

lENTAR  JIKsiNG  PROCEDURES 


FOR 


tAINING  SCHOOLS  FOR  NURSES 


! 


li 


California 

SrrrF,  Printixq  Oi  i-u  i: 
101  --) 


CALIFORNIA  STATE  BOARD  OF  HEALTH 

BUREAU  OF  REGISTRATION  OF  NURSES 


ELEMENTARY  NURSING  PROCEDURES 


FOR 


TRAINING  SCHOOLS  FOR  NURSES 


Caufobnia 
State  Prtntixo  Offtci: 

1  n  1  5 


CALIFORNIA  STATE  BOARD  OF  HEALTH 

BUREAU     OF    REGISTRATION     OF    NURSES 


ELEMENTARY  NURSING  PROCEDURES 


FOR 


TRAINING  SCHOOLS  FOR  NURSES 


California 

State  Printing  Office 

1915 


20531 


PREFATORY  NOTE. 

This  illustrated  j)amphlet  of  elementary  nursing  procedures  is  issued 
to  instructors  of  nurses  in  the  training  schools  of  this  State,  and  has  for 
its  purpose  the  establishment  of  a  certain  degree  of  uniformity  in  teach- 
ing fundamental  nursing  technic  and  to  serve  as  a  guide  to  the 
instructor  during  the  preliminary  part  of  the  course. 

It  illustrates  the  method  of  carrying  on  a  series  of  demonstrations 
which  will  cover  a  period  of  three  months'  class  instruction  before  the 
student  is  permitted  to  undertake  the  care  of  patients.  It  is  not 
intended  to  take  the  place  of  the  textbook,  but  to  emphasize  points 
preliminary  to  bedside  nursing.  Blank  leaves  are  left  for  instructor's 
notes. 

A  li.st  of  articles  required  for  equipment  of  demonstration  room  is 
given.  This  list  may  be  amplified  according  to  the  requirements  of  the 
service  of  the  hospital,  the  facilities  of  the  training  school  and  the  scope 
of  preliminary  instruction. 

Anna  C.  Jamme,  Director. 

Sacramento,  December  10,  1915. 


52 


EQUIPMENT  FOR  DEMONSTRATION  ROOM. 


FURNITURE. 

Students'  chairs. 

Unvarnished  table  (3  feet  by  6  feet). 

Instructor's  table  and  chair. 

Blackboard  (large  size). 

Skeleton. 

Anatomical  charts,  drawings,  etc. 

Pencil  sharpener. 

Bed  and  mattress. 

UTENSILS. 

2  large  enamel  basins. 
2  small  enamel  basins. 
2  .small  enamel  bowls. 
2  curved  basins. 

1  foot  tub. 

2  enamel  pitchers  (2  qt.). 

1  enamel  graduate   (16  oz.  500  c.c). 

1  bed  pan. 

1  douche  pan. 

1  irrigator  and  stand. 

1  saucepan   (1  qt.). 

1  large  tray. 

1  medium  size  tray. 

1  small  tray. 

2  small  glass  jars. 
1  small  glass  dish. 

1  glass  graduate   (500  c.c). 

1  clinical  thermometer. 

1  bath  thermometer. 

1  glass  douche  point. 

2  glass  catheters. 

4  medicine  glasses. 

1  h.ypodermic  syringe. 

2  hypodermic  needles. 

2  hypodermoclysis  needles. 
1  hjT^podermoclysis  bottle. 
1  stupe  wringer. 


ET.KMKXTArxY  NTRSIXG   PROCEDURES. 
LINEN. 

6  large  sheets. 

4  draw  sheets. 
6  pillow  slips. 
6  bath  towels. 
6  hand  towels. 
6  wa.sh  cloths. 

6  dressing-  towels. 
2  bed  blankets. 
1  long  mattress  pad. 
1  small  quilted  pad. 

5  bath  blankets. 
1  bed  spread. 

RUBBER  GOODS. 
1  long  rubber  sheet. 
1  small  rubber  sheet. 
1  piece  Stork  sheeting   (18x24). 
1  piece  bed  rubber  sheeting   (24x36). 

1  rubber  ring. 

2  ice  caps. 

1  rectal  tube. 

1  hard  rubber  rectal  point. 

1  rubber  catheter. 

1  proctoclysis  point. 

2  hot  water  bags. 

1  pair  rubber  gloves. 

1  rubber  apron. 

1  Davidson's  syringe. 

MISCELLANEOUS. 
Vaseline. 

Application  sticks. 
Toothpicks. 
IMouth  wash. 
Comb  and  brush. 
1  small  dressing  forceps. 
Small  whisk  broom. 
Toilet  soap. 
Talcum  powder. 

DRUGS. 

Blank  tablets. 

Suppositories  (cocoa  butter). 

Alcohol  (70%). 

Turpentine,  4  oz. 

Mustard. 

Lysol  solution  (10%). 

Carbolic  solution  (10%). 

Boracic  acid. 

Bichloride  solution   (1-1000). 

Bichloride  tablets  (7-^  grs.). 

Common  salt. 


6  CALIFORNIA   STATE   BOARD   OF   HEALTH. 

FIRST  DEMONSTRATION. 

MAKING   A    BED. 
Articles   required. 

1.  Bed. 

2.  ]\rattress  of  hair,  cotton,  or  ostermoor,  to  fit  bed. 

3.  Two  pillows,  one  feather  and  one  hair  or  both  feather  of  medium 

size,  moderately  well  filled. 

4.  ]\Iattress  pad,  length  and  width  of  mattress. 

5.  Enbber  sheet,  double  coated,  without  wrinkles,  creases  or  pinholes. 

6.  Rubber  protector,  quilted  pad  36  in.  by  24  in.,  or  width  of  rubber 

sheeting. 

7.  Two  sheets,  large  enough  to  tuck  under  mattress  on  all  sides. 

8.  Draw  sheet,  single  or  double. 

9.  Two  pillow  slips  to  fit  pillows  loosely. 

10.  Two  blankets — single  blankets  preferred. 

11.  Spread,  dimity  preferred. 

Procedure. 

Spread  mattress  pad  over  mattress.  Spread  sheet  right  side  upper- 
most, wide  hem  at  top,  allow  it  to  come  well  over  head  of  mattress  and 
turn  corners  wdth  box  effect ;  see  that  it  is  smooth  and  firm. 

Spread  rubber  sheet  across  center  of  mattress  and  over  this  the  rubber 
protector  and  then  draw  sheet.  Pull  latter  down  snugly  by  grasping 
ends  only  and  tuck  in  very  securely  on  each  side. 

Spread  top  sheet,  right  side  down,  wide  hem  at  top,  the  width  of  hem 
al)ove  edge  of  mattress,  tuck  in  securely  at  foot,  box  corners. 

Spread  each  blanket,  leave  about  ten  inches  from  top  edge  of  mat- 
tress ;  tuck  in  each  blanket  separately  at  foot  of  bed,  box  corners.  Turn 
down  top  sheet  over  upper  edge  of  blanket,  tuck  in  blankets  and  top 
sheet  securely  on  each  side  of  mattress.  The  l>ed  should  now  be  smooth, 
firm  and  corners  perfectly  square. 

Place  spread  with  upper  edge  even  with  mattress,  tuck  in  at  foot, 
square  corners  and  alloAv  spread  to  hang  at  each  side. 

Pillows  slipped  into  cases  by  first  placing  pillows  on  chairs  and  not 
on  bed,  corners  of  pillows  to  fit  well  into  covers.  First  pillow  or  hair 
pillow,  if  used,  laid  flat  on  bed,  seam  side  to  head  of  bed,  open  end  away 
from  door.  Second  pillow  standing  upright,  seam  side  at  lower  border, 
open  end  away  from  door. 

SECOND  DEMONSTRATION. 

TO  OPEN   BED   FOR  OCCUPANCY. 
Procedure. 

Remove  pillows  to  chair  or  foot  of  bed.  Turn  back  spread  about  four- 
teen inches.  Loosen  blankets  and  top  sheet  at  sides,  turn  up  top  sheet 
towards  head  of  bed,  bring  up  spread  and  turn  upper  edge  over  border 
of  blankets.  Turn  back  sheet,  make  one  more  turn  so  that  last  turn 
shall  be  twelve  inches  wide. 

Place  pillows  one  over  the  other,  closed  ends  on  one  side.  See  that 
bed  clothing  is  perfectly  smooth,  no  wrinkles  or  loose  corners. 


ELKMKNTARY  NURSINO    I'lfOfVEDUEES.  7 

THIRD  DEMONSTRATION. 
TO   STRIP  AND   AIR   A    BED. 
•Procedure. 

Place  two  chairs  back  to  back.  Remove  pillows,  place  one  on  each 
chair.  Loosen  sheets  and  blankets  around  mattress,  remove  spread  and 
fold  in  creases,  place  over  chairs.  Remove  blankets,  each  separately  by 
gathering  in  hands  while  standing  at  side  of  ))ed. 

Remove  upper  sheet  and  draw  sheet  in  same  manner.  Hang  rubber 
sheet  and  small  pad  on  foot  of  ])ed.  mattress  protector  on  head  of  bed. 


FOURTH  DEMONSTRATION. 

TO   MAKE  A  SURGICAL   BED. 
Articles   required. 

Same  as  for  First  Demonstration,  and  in  addition — 

1.  Two  special  or  bath  blankets. 

2.  Stork  sheeting  18  x  24  inches. 

3.  Two  towels. 

4.  Four  small  safety  pins. 

5.  Three  hot  v/ater  bags  or  cans. 

Procedure. 

Spread  mattress  protector,  lower  sheet,  rubber  sheet,  small  pad  and 
draw  sheet  as  in  making  ordinary  bed.  Spread  special  blankets  six 
inches,  from  top  of  mattress ;  spread  top  sheet  width  of  hem  above  upper 
edge  of  mattress,  do  not  tuck  in  at  bottom  of  mattress. 

Spread  bed  blankets  as  in  ordinary  bed  and  do  not  tuck  in  at  bottom. 
Put  on  spread,  or  if  preferred,  a  sheet. 

Turn  over  upper  bed  clothes,  including  the  upper  special  blanket,  at 
foot  of  bed  and  make  an  even  fold  8  to  10  inches  in  width  with  lower 
edge  of  fold  on  level  with  end  of  mattress. 

Turn  over  in  same  way  at  head  of  bed  and  on  one  side,  that  most 
convenient  for  placing  patient  in  bed,  making  neat  smooth  folds  same 
width  as  at  foot.     Tuck  in  bedding  on  opposite  side. 

Place  small  rubber  sheet  covered  with  towel  and  held  in  place  with 
safety  pins,  where  patient's  head  will  rest.  Place  hot  water  bags,  or 
cans,  where  shoulders,  hips  and  feet  will  rest.  These  should  be  filled 
with  very  hot  water  and  in  every  case  removed  before  the  patient  is 
placed  in  bed. 

Lower  blanket  may  ])e  omitted  and  used  only  in  case  of  shock  or  when 
additional  warmth  is  required. 

Bedside  table.  On  table  should  be  one  (preferably  two)  emesis 
basins,  towels  and  several  small  scfuares  of  gauze. 


8 


CALIFORNIA   STATE   BOARD   OF    HEALTH. 


FIFTH  DEMONSTRATION. 
TO   MAKE  A  DELIVERY   BED. 
Articles  required  for  demonstration. 

Same  as  for  First  Demonstration,  and  in  addition — 

1.  Long  rubber  sheet,  length  and  width  of  mattress. 

2.  One  long  sheet  and  draw  sheet. 

3.  Four  large  safety  pins. 

4.  One  light  warm  blanket. 

Procedure. 

Proceed  as  in  making  ordinary  bed  until  after  draw  sheet  is  tucked 
in,  then  cover  bed  with  long  rubber  and  over  this  place  extra  sheet,  tuck 
in  on  all  sides,  then  extra  draw  sheet  and  pin  securely  to  mattress  with 
large  safety  pins. 

For  the  delivery  a  sterile  sheet  is  placed  over  this.  After  delivery 
both  sheets  and  long  rubber  are  removed  and  patient  is  on  clean  bed- 
ding.    Blanket  will  cover  patient. 


' 

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A   quilted   pad   protects   the   mattress. 


ELEMENTARY  KUHSING  rROCEDDRES. 


The   lower    sheet    in    place. 


A  small  quilted  pad  covers  the  rubber  sheet  and  lessens  the  discomfort  of  the  rubbe 


2—20531 


10 


CALIFORNIA   STATE   BOARD    OF   HEALTH. 


The    draw    sheet    in    place. 


The   upper   sheet   is   turned   back    on   top    of   blanket. 


ELEMENTARY  NURSING  PROCEDURES. 


11 


The   closed   bed. 


In    opening    the   bed   for   occupancy   the    spread   is    turned    over    the    upper    border    of 

blanket. 


]2 


CALIFORNIA    STATE   BOARD   OP    HEALTH. 


The  bed  is  open  for  occupancy.     One  or   both  pillows   may  be   used. 


Taking  off  the  blanket  to  air  the  bed. 


ELEMENTARY  NURSING  PROCEDURES. 


13 


Bed   stripped   for   airing. 


A   surgical    bed   without    blankets. 


14 


CALIFORNIA   STATE   BOARD   OF   HEALTH. 


A   sursical   bed   with   blankets  for   additional   warmth. 


The   Hospital    Doll. 


ELEMENTAEY  NUESIXG  PROCEDURES.  15 

INSTRUCTOR'S   NOTES. 


16  CALIFORNIA    STATE   BOARD    OP   HEALTH. 

INSTRUCTOR'S   NOTES. 


i:i.i;mi;\"iaky  xiMtsixc  I'Uockdfrks.  17 

SIXTH  DEMONSTRATION. 
THE    BED-BATH. 
Articles   required. 

1.  Bed  ])rei)ared  for  occupancy. 

2.  Subject  for  bath  (model  doll,  nurse,  or  patient). 

3.  Two  bath  blankets. 

4.  One  bath  towel. 

5.  Two  face  towels. 

6.  Two  wash  cloths. 

7.  Soap,  alcohol  (50%).  toilet  powder,  curved  basin.  toothl)rush,  comb 

and  brush,  tooth  paste,  or  mouth  wash. 

8.  Two  pitchers  containing  cold  and  hot  Avater. 

9.  Basin,  slop  jar.  hot  water  bag,  bath  thermometer. 

Procedure. 

Have  two  chairs  at  foot  of  bed,  loosen  bedding  from  all  around  mat- 
tress; remove  spread  and  blanket,  as  in  stripping  bed,  and  place  on 
chairs ;  spread  bath  blanket  over  upper  sheet ;  remove  sheet  in  a  down- 
ward direction  while  holding  upper  border  of  blanket. 

Remove  patient's  gown  by  first  drawing  up  gown  from  under  hips, 
then  remove  one  sleeve  and  while  supporting  the  patient  remove  the 
gown  over  the  head  and  other  arm. 

When  patient  can  not  be  raised,  turn  first  on  one  side  and  remove  one 
sleeve,  then  bringing  the  goA\Ti  over  the  head,  turn  on  back  and  remove 
it  entirely. 

Place  second  bath  blanket  under  patient  by  first  turning  her  on  one 
side,  then  place  half  of  blanket  over  one  side  of  bed,  turn  patient  back 
and  draw  blanket  over  other  side. 

The  patient  is  now  between  two  bath  blankets.  If  recjuired,  place  hot 
water  bag  at  feet ;  place  one  face  towel  on  upper  border  of  top  blanket 
and  turn  well  over  edge  to  keep  blanket  from  coming  in  contact  with 
chin.     Remove  one  pillow  and  place  towel  under  patient's  head. 

To  give  the  bath. 

Bathe  face,  using  wash  cloth  so  that  ends  will  not  drip  or  drag  over 
skin ;  wash  carefully  in  corners  of  eyes,  around  nose  and  mouth  and 
under  chin.  Do  not  use  soap  unless  requested.  Dry  thoroughly. 
Bathe  neck  and  ears.  l)eing  careful  not  to  fill  ears  with  soapy  water,  dry 
thoroughly,  especially  behind  ears. 

Spread  bath  towel  under  one  arm  and  over  edge  of  blanket.  Use 
second  wash  cloth  and  bathe  arms  Avith  soapy  water,  using  a  firm  even 
motion  and  giving  special  attention  to  axilla.  While  bathing  arm.  the 
nurse  should  support  it  l)y  placing  hand  under  patient's  wrist,  and 
never  allow  it  to  drop  suddenly.  After  arms  are  well  dried  with  bath 
toAvel,  place  hand  towel  on  l)ed  and  over  this  set  basin  and  immerse 
patient's  hand  in  Avater.  After  A\-ashing  thoroughly,  remove  basin  and 
dry.  Bathe  other  liand  in  same  manner.  Renew  Avater  in  basin,  bathe 
chest  next,  using  fii-ni  circular  strokes.  A])douien  is  then  bathed,  work- 
ing under  ])lanket  in  oi'der  not  to  expose  })atient. 

3— 20.131 


18  CALIFORNIA   STATE   BOARD    OP   HEALTH. 

Patient  is  then  turned  on  side,  bath  towel  placed  over  lower  blanket 
and  brought  close  to  back,  back  is  bathed,  using  firm  circular  strokes, 
dry  thoroughly,  finishing  with  long  strokes  down  spine.  Renew  water 
in  basin.  Expose  one  thigh,  place  bath  towel  over  blanket,  bathe  from 
hip  to  knee  and  dry.  Expose  lower  leg  and  bathe  from  knee  to  ankle. 
Bathe  other  leg  in  same  manner,  covering  patient  with  blanket  after 
finishing  each.  Have  patient  flex  knees,  place  bath  towel  on  bed,  over 
this  set  basin  (not  too  full)  and  place  one  foot  at  a  time  in  basin,  bathe 
carefully  and  allow  it  to  remain  for  a  few  minutes  in  the  water.  Renew 
water. 

In  giving  a  bath  to  a  female  patient,  the  genitals  are  then  bathed,  if 
a  male  patient,  this  is  done  by  the  orderly,  or  by  the  patient  himself. 
In  the  latter  instance  the  nurse  places  wash  cloth  and  towel  conveniently 
near  and  leaves  the  room  until  the  patient  summons  her  by  ringing 
the  bell. 

A  general  alcohol  rub  may  be  given  at  this  point,  or  it  can  be  given 
after  each  part  has  been  bathed.  Talcum  powder  may  also  be  used  if 
desired. 

The  night  gown  is  then  put  on  by 'putting  first  one  arm,  then  the 
other,  into  the  sleeves  and  slipping  it  over  the  head,  shoulders  and  under 
hips.  Turn  patient  on  side  to  remove  lower  bath  blanket  and  change 
sheet  and  draw  sheet.  This  is  done  by  pushing  up  soiled  lower  sheet 
and  clean  sheet  close  to  patient 's  back,  put  on  clean  lower  sheet  on  half 
of  bed,  turn  corners  and  tuck  in  firmly.  Put  on  draw  sheet  on  half  of 
bed,  folding  the  remainder  of  both  sheets  in  flat  folds  close  to  patient's 
back  with  edge  towards  opposite  side.  Go  to  other  side  of  bed  and  turn 
patient  over,  draw  out  soiled  sheets,  take  edge  of  lower  sheet  and  draw 
over,  pulling  securely,  tuck  in  corners  in  usual  manner.  Straighten 
rubber  and  rubber  protector ;  take  edge  of  clean  draw  sheet,  pull  and 
tuck  securely  in  place.  Patient  is  then  turned  on  back,  upper  sheet  put 
on  and  upper  bath  blanket  removed.  Blankets  and  spread  are  put  on 
as  in  making  the  ordinary  bed.  Pillow  slips  are  changed.  In  doing 
this  the  pillow  should  never  be  placed  on  the  bed  but  put  on  a  chair  or 
table ;  patient  is  raised  and  supported  and  pillows  adjusted  comfortably 
under  shoulders  and  head. 

The  care  of  the  mouth,  hair  and  finger  nails  is  part  of  the  bath  routine. 
To  clean  the  nails,  a  hand  towel  is  placed  over  the  spread  under  the 
hands,  file  and  orangewood  stick  laid  on  it.  If  patient  is  well  enough 
she  may  prefer  to  do  this  for  herself. 

To  clean  the  mouth,  place  hand  towel  under  chin  and  have  patient 
brush  the  teeth,  or  if  unable  to  do  so,  nurse  must  clean  carefully  with 
a7)plicator,  or  gauze  over  finger.  Have  patient  rinse  mouth  with  mouth 
wash,  adjust  curved  basin  under  chin  for  expectoration. 

To  arrange  the  hair,  a  hand  towel  is  laid  over  the  pillow,  the  patient's 
head  turned  to  one  side  and  the  hair  divided  into  two  parts,  brush  care- 
fully and  somewhat  slowly,  combing  must  be  done  gently,  the  hair  being 
held  in  the  hand  to  prevent  pulling.  After  tangles  are  removed,  the 
hair  is  braided  near  the  ears  and  the  ends  of  the  braid  tied.  In  doing 
the  hair  the  nurse  stands  on  either  side  of  the  bed;  she  should  never 
work  across  the  patient. 

In  male  patients  the  hair  must  be  carefulh^  brushed  with  special 
attention  to  the  back  of  the  head. 


ELEMEXTAUY   XURSIXG   PROCEDURES. 


19 


Articles  prepared   for   giving   the   bath. 


20 


CALIFORNIA   STATE   BOARD    OF   HEALTH. 


Patient   prepared   for   bed   bath. 


Bathing  the  face. 


ELEMEXTATtY  NTRSIXG  PROCEDURES. 


21 


Bathing   the    arm. 


Bathing   the   hand. 


22 


CALIFORNIA    STATE    BOARD    OF    HEALTH. 


Bathing   the  leg. 


"W 


Bathing  the  foot. 


KLEMENTAKY  NURSING   rilOCEDURES. 


23 


Putting   on    the    gown. 


Changing  the  lower  bedding. 


24 


CALIFORNLV   STATE   BOARD   OF    HEALTH. 


The  nurse  assisting  the   patient  in  brushing  the  teeth. 


The   nurse   brushes   the   hair   carefully. 


ELEMENTARY  NUKSING  PllOCEDURES.  25 


Attention  to   finger  nails. 

SEVENTH  DEMONSTRATION. 
PREPARATION   OF   PATIENT   FOR  THE   NIGHT. 
Articles  required. 

1.  Basin  with  -warm  water. 

2.  Hand  towel  and  wash  cloth. 

3.  Curved  basin,  tooth  brn.sh,  tooth  paste  or  mouth  wash. 

4.  Comb  and  brush. 

5.  Alcohol  (50%),  and  talcum  powder. 

6.  Small  whisk  broom. 

Procedure. 

Place  hand  towel  under  chin,  wash  face  and  dry.  Spread  hand  towel 
over  spread,  set  basin  conveniently  on  either  side,  immerse  hand,  wash 
with  soap  and  water,  allowing  each  hand  to  remain  a  fe^v  minutes  in  the 
water.  Place  hand  towel  under  chin  and  have  patient  cleanse  mouth  as 
in  Sixth  Demonstration.     Rearrange  hair  if  necessary. 

Have  patient  use  bed  pan  or  urinal.  If  female,  wash  genitals  and 
douche  externally,  dry  with  cotton  or  gauze.  Turn  patient  on  side, 
brush  out  crumbs,  using  small  whisk  broom  (kept  for  this  purpose). 
Loosen  draw  sheet  from  side  of  mattress,  also  rubber  sheet  and  lower 
sheet,  pull  firmly  and  retuck  under  mattress  snugly. 

Rub  back  and  over  hips,  using  firm  circular  strokes,  finishing  with 
long  strokes  down  spine.  Turn  patient ;  go  to  opposite  side  of  bed  and 
proceed  as  before,  pull  nightgown  down  in  place. 

Turn  spread  and  blankets  over  foot  of  bed,  straighten  top  sheet,  turn 
back  each  blanket  separately  over  patient ;  turn  spread  over  upper  edge 
of  blanket,  turn  back  upper  sheet.     Remove  i)illo\vs.  sliake  and  adjust 
comfortablv.     See  that  bell  is  within  reach. 
4— 20.-)3i 


2f;  CALIFORNIA    STATE   BOARD    OF    HEALTH. 

INSTRUCTOR'S   NOTES. 


KI.KMKXTAIJY    Mi;s|\(!    I'ltOCKDr  ItKS.  27 

EIGHTH  DEMONSTRATION. 

TAKING   THE   TEMPERATURE. 
Articles   required. 

1.  Clinical  thci  inoiuctcr  fov  iiivtni('t(»i'  and  out'  for  each  nienihor  of 

the  ehiss. 

2.  One  rei-tal  thcnnoiuetei". 

3.  Gla.ss  holding'  solution  (TO^f  alcohol)  and  cotton. 

4.  Small  dish  holding  squares  of  gauze  or  cotton  pledgets. 

5.  Small  jar  of  vaseline. 

6.  One  liand  towel. 

Procedure.      By   mouth. 

Remove  thermometer  from  solution,  wipe,  .shake  down  mei'cury  to 
95  degrees  by  holding  end  of  thermometer  firmly  between  tirst  and 
second  fingers  and  thumb — giving  a  sharp  wrist  movement.  Place  in  a 
slanting  position  under  side  of  tongue  and  have  patient  close  mouth.  If 
the  lips  are  dry  they  should  be  moistened  before  the  thermometer  is 
introduced.  The  patient,  if  out  of  bed.  should  not  be  standing.  A  hot 
or  cold  drink  should  not  be  given  for  several  minutes  before  the  ther- 
mometer is  placed  in  the  mouth.  The  thermometer  should  be  held  for 
at  least  three  minutes.  Remove,  wipe,  and  return  to  the  solution.  The 
temperature  should  be  recorded  at  once. 

By  axilla. 

Wipe  axilla  with  towel  to  remove  any  moisture,  shake  mercury  down, 
place  bulb  well  in  hollow  of  axilla,  bring  arm  across  chest  and' hold  in 
position  for  five  minutes.     Remove,  read  and  record  at  once. 

By   rectum. 

I'se  special  rectal  thermometer,  have  patient  turned  on  one  side  with 
knees  flexed.  Shake  down  mercury,  lubricate  with  vaseline  and  insert 
gently  in  rectum  about  one  inch ;  allow  it  to  remain  for  three  minutes. 
Remove,  wipe,  read  and  record  at  once. 

Note. — Variations  in  temperature  and  reasons  for  same  are  taught  by  instructor. 


The  thermometer  tray. 


28 


CALIFORNIA    STATE   BOARD    OF    HEALTH. 


Placing  the  thermometer  under  the   tongue.  Holding    the    thermometer. 


The  thermometer  in   the  axilla. 


ELEMENTARY   ^•I'T?^;T^•(;    I'HOCEDrRES.  29 

NINTH  DEMONSTRATION. 
PULSE   AND    RESPIRATION. 
Articles   required. 

The  iustruetor  and  each  member  of  tlie  class  must  liave  a  watch  with 
second  hand. 

]\rembers  of  the  class  act  as  subjects  in  turn. 

Procedure.      To  count  the  pulse  at  the  wrist. 

Subject  to  be  lying-  down  or  sitting,  arm  at  rest.  The  student  places 
the  two  first  fingers  on  inside  surface  of  the  wrist,  one  inch  below  the 
root  of  the  thumb  and  in  the  depression  made  by  the  radius  and  flexor 
tendons,  the  pulsation  of  the  artery  will  be  easily  felt,  the  number  of 
beats  are  counted  for  one  minute  and  recorded  immediately. 

To  count  the  pulse  at  the  temple. 

The  first  two  fingers  are  placed  over  the  temporal  artery  immediately 
in  front  of  the  ear  and  the  pulsation  counted  for  one  minute. 

XoTE. — Characteristics  of,  and  variations  in,  pulse  are  tauglit  by  tlie  instructor. 
Counting  the  respiration. 

This  is  done  immediately  after  the  pulse  is  counted  and  while  the 
hand  is  still  on  the  wrist.  The  patient  should  not  be  aware  it  is  being 
done.     The  number  of  respirations  should  be  counted  for  one  minute. 

Note. — Characteristics  of  and  variations  in  respiration  are  taught  by  the  instructor. 


TENTH  DEMONSTRATION. 

CHARTING. 

Articles  required. 

1.  Chart  forms. 

2.  Fine  pen  points,  holders,  black  and  red  ink.  and  a  six-inch  ritle  for 

each  member  of  the  class. 

Procedure. 

All  lettering  must  be  done  in  neat  legible  type.  Fill  out  every  blank 
space.  Chart  temperature,  pulse  or  respiration  with  small  dots  uniform 
in  size,  the  line  connecting  the  dots  must  be  straight  and  light,  there 
must  be  no  erasures. 


30 


CALIFORNIA    STATE    BOARD    OF    HEALTH. 


Taking  the  pulse  at  the  wrist.      Note  the  position  of  arm. 


Taking  the  pulse  at  the  temple  over  temporal  artery. 


Ei.KMivS'TAitv  XF'iisixd  )'iiori;i)rni':;s. 


ai 


Taking  the  pulse  in  the  neck   over  carotid   artery. 


82 


CAI.IKOKXIA    STATK    BOARD    OF    IIEAI.TII. 


OAIE  |2/    I  22    23   I  24-  I  25  1 26  I  27  ,^a    \Z9    130   |3/    ff  I  2     |  3    U       5"       G       7       fl        9/0 

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Facsimile   of    clinical    chart    made    by    student    in    a    training    school    in    California. 


i:i.i':Mi;\'i'.\m   m'ksinc  i'i;()('i:i)ri;KS. 


33 


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Facsimile   of   baby's   weight    chart   made    by   a    student   in    a    training    school    in    California. 


34 


CALIFORNIA   STATE   BOARD   OF    HEALTH. 


DpOiQAVt.: No >S., 

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Facsimile   of   bedside   record   made   by   a   student   in   a   training   school   in    California. 


ELEMENTAliY    NrUSTNG    PROCEDURES.  35 

INSTRUCTOR'S   NOTES. 


36  CALIFORNIA    STATE    BOARD    OF    HEALTH. 

INSTRUCTOR'S   NOTES. 


i:i.i-:.Mi:x'i"Ai!Y  xrifsixd  i'iio(i:i)ri;i:s.  37 

ELEVENTH  DEMONSTRATION. 

GIVING   AN    ENEMA. 
Articles  required. 

1.  Bed  prepari'd  fci-  ociiipanc}-. 

2.  Hospital  doll. 

3.  Rubber  sheet  20  by  80  inches. 
•1.  Sheet  or  small  blanket. 

5.  Bath  towel. 

6.  Irrigating  can  and  stand. 

7.  Hard  rubber  rectal  nozzle  and  soft  rubber  rectal  tube. 

8.  Bed  pan  and  cover. 

9.  Vaseline,  bath  thcnnomcter.  toilet  paper,  paper  bags. 

10.  Pitcher  or  glass  graduate  holding  two  quarts  (2.000  e.c.)  of  .soap 

solution — temperature  100  degrees  Fahrenheit. 

11.  Small  pitcher  or  graduate  to  hold  warm  cleansing  fluid. 

Procedure. 

Rubber  sheet  covered  with  bath  towel  is  placed  under  hips;  patient 
turned  on  left  side,  hips  to  edge  of  bed.  knees  flexed,  right  knee  brought 
up  more  than  left.  Draw  up  night  gown  over  hips.  Cover  shoulders, 
hips  and  legs  with  sheet  or  small  blanket.  Turn  down  bed  clothes  over 
feet. 

Soap  solution  is  poured  into  irrigating  can  and  hung  about  two  feet 
above  buttocks.  Nozzle  or  rectal  tube  is  adjusted  and  solution  allowed 
to  flow  into  bed  pan  to  expel  air  and  warm  tube.  A  small  but  sufficient 
amount  of  vaseline  is  spread  over  tip.  Lift  edge  of  sheet  or  blanket 
with  one  hand,  and  with  the  other  insert  point  gently  and  in  a  .slightly 
upward  and  forward  direction;  allow  solution  to  run.  If  there  is  com- 
plaint of  pain,  clamp  tube  for  a  few  minutes.  When  fluid  is  exhausted, 
or  as  much  as  patient  can  take  has  been  given,  clamp  tube,  withdraw, 
wrap  in  toilet  paper  and  drop  into  paper  bag.  Place  patient  on  back, 
adjust  bed  pan  by  flrst  placing  hand  over  sacral  region  and  raising 
slightly.  When  removing  soiled  bed  pan,  have  a  clean  and  warmed  bed, 
or  douche  pan  ready  to  slip  under  hips.  Take  soiled  pan,  covered,  from 
room.  Cleanse  and  irrigate  vulva  and  aniLs  thoroughly,  remove  pan 
and  dry,  remove  rubber  sheet  and  towel.  In  cases  where  patient  can  not 
be  turned  on  one  side,  enema  may  be  given  in  dorsal  position. 

Note. — ^Various  formulae,  their  purpose  and  effect  will  be  taught  by  instructor. 


38  CALIFORNIA    STATE   BOARD   OF    HEALTH. 

TWELFTH  DEMONSTRATION. 
GIVING  VAGINAL  DOUCHE. 

Articles   required. 

1.  Bed  prepared  for  oeciipaney. 

2.  Hospital  doll. 

3.  Douche  can  and  tu])ing  (sterilized). 

4.  Glass  douche  point  (sterilized). 

5.  Bath  thermometer  (sterilized  in  carbolic  or  lysol  solution  10  per 

cent— 1-10). 

6.  Solution — two  quarts  (2,000  c.c),  temperature  105  degrees  to  110 

degrees,  in  sterilized  pitcher  or  glass  graduate. 

7.  Jar  of  cotton  pledgets  or  gauze,  paper  bag. 

8.  Bath  towel,  sheet  and  chest  blanket. 

9.  Warmed  douche  pan,  folded  towel  on  back  of  pan  where  hips  rest. 
10.  Hot  water,  soap  and  solution  for  nurse's  hands. 

Procedure. 

Place  bath  towel  under  hips,  draw  night  gown  well  up  under  back, 
cover  patient  with  sheet  and  chest  blanket.  Place  sheet  crosswise  and 
use  a  reverse  fold,  or  twist,  in  center  and  fold  around  each  leg,  small 
blanket  over  chest,  if  desired.  Turn  down  upper  bedding  to  cover  feet, 
adjust  douche  pan  comfortably.  Pour  solution  into  can  and  hang  about 
twenty  inches  above  bed.  Scrub  hands  thoroughly  with  hot  water  and 
soap,  using  running  water  if  possible,  riiLse  well  and  soak  for  one  minute 
in  lysol  1  per  cent  or  alcohol  70  per  cent.  Adjust  point  to  tube  and 
allow  solution  to  run  until  air  is  expelled  and  tube  is  warm.  Douche 
over  vulva,  separate  labia,  douche  vaginal  outlet,  not  allowing  nozzle  to 
touch  patient.  Insert  douche  point  in  vagina  downward  and  backward 
and  while  solution  is  flowing,  turn  point  gently  round  and  round  in 
order  that  every  part  of  the  cavity  may  be  cleansed.  Kemove  tube 
before  solution  is  completely  exhausted ;  leave  patient  on  pan  for  a  few 
minutes,  dry  w^ell  around  vulva  with  cotton  or  gauze.  Remove  pan, 
dry  back. 

Note. — Medicated  douches  and  precautions  in  administering  same  are  taught  by 
instructor. 


i:i,i:.Mi:\'iAi;v  xi'itsixc!  iMtociiDiKKS.  39 

THIRTEENTH  DEMONSTRATION. 
CATHETERIZATION. 
Articles  required. 

1.  Bed  prepared  for  oc-cnpancy. 

2.  Hospital  doll. 

3.  Tray  covered  with  towel  on  which  are  the  following:  one  dressing 

towel,  bowl  for  warm  .solution  of  boric  acid  (2%),  ba.sin  to 
receive  urine,  package  containing  at  least  12  sterile  pledgets, 
paper  bag.  Two  glass  catheters  and  one  soft  rubber  catheter 
basin  for  boiling  catheters. 

4.  Basin  containing  solution  for  nurse 's  hands. 

5.  One  large  sheet  and  a  small  chest  blanket. 

6.  Douche  pan. 

Procedure. 

Place  catheters  in  basin,  cover  well  with  water  and  boil  for  ten 
minutes.     Pledgets  may  be  boiled  at  same  time. 

Preparation   of  patient. 

Place  patient  on  back,  knees  flexed,  night  gown  drawn  up.  Cover 
with  sheet  and  chest  blanket,  turn  down  upper  bedding  over  feet. 
Drape  sheet  by  giving  a  reverse  fold  in  center  and  folding  ends  around 
each  leg.  Place  patient  on  douche  pan,  cleanse  vulva  with  warm  water 
and  soap.  Remove  douche  pan.  Take  one  towel  and  place  one  end 
slightly  under  hips,  on  this  place  basin  to  receive  urine,  turn  up  other 
end  of  towel  over  basin  and  vulva.  Remove  catheter  basin  from  stove 
and  place  on  tray. 

Nurse's  hands. 

Scrub  hands  thoroughly  with  soap  and  water,  cleanse  around  nails, 
scrub  again  and  rinse  in  hot  running  water,  then  immense  for  one 
minute  in  lysol  1  per  cent,  or  alcohol  70  per  cent. 

Lower  towel  covering  vulva  by  a  motion  of  the  elbow,  or  it  may  be 
done  by  the  patient  when  catheterizing  without  assistance. 

Sponge  vulva  in  a  downward  direction  with  pledget  saturated  in  boric 
solution.  Separate  labia  with  first  two  fingers  of  left  hand  and  hold  in 
this  position  until  catheter  is  passed.  Take  fresh  pledget  and  cleanse 
meatus  with  gentle  downward  movement,  using  at  least  four  pledgets. 
Place  a  small  pledget  at  entrance  to  vagina.  Pick  up  one  of  the  glass 
catheters  at  open  end;  examine  point  closely  to  ascertain  if  there  is  a 
crack ;  see  that  point  does  not  touch  anything  before  it  is  inserted. 
Insert  carefully  in  urethra  for  about  three  inches,  or  until  urine  starts  to 
flow;  change  direction  of  catheter  if  urine  does  not  flow. 

After  urine  has  ceased,  remove  catheter,  placing  one  finger  on  open 
end  and  put  in  paper  bag,  sponge  vulva,  remove  basin  of  urine,  arrange 
patient  comfortably.  Measure  and  record  amount  of  urine  at  once.  If 
for  bacteriological  examination,  basin  and  receptacle  must  be  .sterile. 

Note. — Characteristics  of  normal  and  abnormal  urine  will  be  taught  by  instructor. 


40 


CALIFORNIA    8TATE    BOARD    OF    HEALTH. 


Articles   prepared   for    catheterization. 


FOURTEENTH  DEMONSTRATION. 
HYPODERMIC   INJECTION. 


Articles  required. 
1.  Tray  holding 

(a)  Alcohol  lamp. 

(&)   Small  bottle  of  alcohol. 

( c )  Hypodermic  syringe  and  needles. 

(d)  Jar  of  sterile  pledgets. 

(e)  Mimin  glass  of  water,  or  bottle  of  distilled  water. 
(/)   Spoon  for  holding  needle. 

(g)   Small  dressing  forceps. 

(h)   Small  glass  dish  for  drng. 

(?")   Small  box  of  matches  and  bowl  for  waste. 

Procedure. 

First  test  syringe  to  see  that  there  is  no  leakage.  Order  is  then  read 
and  tablet  is  placed  in  glass  dish.  Barrel  of  syringe  may  be  cleansed  by 
drawing  np  alcohol  and  rejecting  it  into  waste  bowl  or  by  boiling. 
Needle  is  then  boiled  in  a  spoonful  of  water  and  removed  with  forceps. 
Draw  up  hypodermic  full  of  boiled  or  distilled  water  and  expel  into 
sterile  teaspoon.  Add  tablet,  when  dissolved  fill  hypodermic ;  screw  on 
needle  securely,  expel  air  and  allow  one  or  two  drops  to  flow  from  point 
of  needle.  A  pledget  moistened  with  alcohol  surrounds  the  needle  which 
is  then  carried  to  the  bedside;  a  second  pledget  moistened  with  alcohol  is 
also  taken. 

Select  location  for  injection  on  upper  and  outer  portion  of  arm  or 
tliigb.  Cleanse  skin  by  ru})])ing  vigorously  with  pledget.  Pincli  up  a 
good  fold  of  skin  and  tissue,  insert  needle  quickly  and  remove  slightly, 
allowing  thumb  to  press  on  piston  of  syringe,  inject  fluid  slowly  at  the 
same  time  slightly  withdraw  needle ;  make  pressure  Avith  pledget  and 
slight  upward  strokes  over  seat  of  injection. 

Note. — Instruftion  in  giving  imperial  and  deep  injections  is  taiiglit  by  instructor. 


i:i.i;mi:ni'akv  Mi!si\(i  i-itocEUURES. 


41 


Hypodermic  tray. 


Boiling   the    Needle. 


42 


CALIFORNIA   STATE   BOARD   OF   HEALTH. 


Filling   the   syringe. 


Expelling  the  air. 


ELEMENTAKY  XURSIXG   riiOCKUrUKS. 


■13 


Carrying    the    syringe    to    the    bedside. 


Inserting  the  needle. 


44  CALIFORNIA   STATE   BOARD    OF   HEALTH. 


Injecting   the    fluid. 


Slight    pressure    at   point   of   injection. 


ELEMENTARY  NURSING    I'ltOC  10 DUKES.  45 

INSTRUCTOR'S   NOTES. 


46  CzVLIFORNIA    STATE    BOARD    OF    HEALTH. 

INSTRUCTOR'S   NOTES. 


I'li.KMKX'i' \m'  Mi;siN(;   i'i;()(i:i)ri;i:s. 


47 


FIFTEENTH  DEMONSTRATION. 

HYPODERMOCLYSIS. 
Articles  required. 

1.  Bed  prepared  for  oceupaney. 

2.  Hospital  doll. 

3.  Larj^e  tray  eontaininji;- 

(a)   Sterilized  ( ontainer  or  .solution  bottle. 

(6)   Special  needles  with  rubber  tubing  attached  (may  be  dry 

Erratum 

(c)      Should  read  "salt  .solution  0.1  ^/("  and  not  "7  per  cent." 

(e)  Bottle  of  tincture  of  iodine  5  per  cent  and  swabs  for  apply- 
ing same. 

(/)  Glass  thermometer  (sterilized  in  lysol  or  alcohol),  paper 
bag.  two  dressing  towels. 

(g)   Collodion  or  a  roll  of  adhesive. 

Procedure. 

Subject  prepared  by  exposing  both  breasts,  surrounding  with  dressing 
towels,  paint  lower  portion  of  breast  heavily  with  iodine. 

Salt  solution  at  temperature  ordered  is  put  into  container  and  hung 
above  patient  at  height  ordered,  tubing  adjusted ;  fluid  is  allowed  to  flow 
through  tube  until  tube  is  warmed.  Needle  is  then  inserted  b3^.,doctor 
and  fluid  absorbed  slowly.  After  needle  is  withdrawn,  the  puncture 
may  be  covered  with  a  sterile  -sciuare  of  gauze  held  in  place  by  a  strip  of 
adhesive  or  sealed  with  collodion. 

Note. — Methods   of  maintaining;  temnerature  of   fluid  are  tauglit  bv  instructor. 


Articles   prepared   for   hypodermoclysis. 


48  CALIFORNIA   STATE   BOARD    OF   HEALTH. 

SIXTEENTH  DEMONSTRATION. 

PROCTOCLYSIS. 

Articles   required. 

1.  Bed  prepared  for  occupancy. 

2.  Hospital  doll. 

3.  Rubl)er  sheet  20  by  30  inches. 
■i.  Bath  towel,  dressing  towel. 

5.  Irrjo-ating  can  and  stand. 

6.  Special  nozzle  or  rubber  catheter  No.  12  E. 

7.  Bath  thermometer. 

8.  Salt  solution  0.6  per  cent  or  one   and  one-half  teaspoons    (90 

grains)   to  one  quart  of  water.     Temperature  100  degrees  to 
110  degrees  Fahrenheit. 

9.  Pitcher  or  glass  graduate  containing  solution. 
10.  Vaseline. 

Procedure. 

Rubber  sheet  covered  with  bath  towel  is  placed  under  hips  of  patient, 
fluid  poured  into  can  which  is  covered  with  towel  and  hung  not  more 
than  6  to  8  inches  above  level  of  bed.  Rate  of  How  is  controlled  by 
gravity.  Allow  fluid  to  run  through  tube  until  tube  is  warm ;  spread  a 
small  amount  of  vaseline  over  nozzle  and  insert  carefully.  If  catheter 
is  used  it  may  be  held  in  place  with  a  strip  of  adhesive  over  top  and 
fastened  to  thigh. 

XOTE. — Methods  of  maintaining  temperature  of  fluid  is  taught  by  instructor. 


Special   proctoclysis   tube. 


i:i.i:Mi:\'rAi!Y  \ri;siv(!  iMtocKDritKs. 


49 


SEVENTEENTH   DEMONSTRATION. 
BATH    TO    REDUCE     TEMPERATURE    (COLD   SPONGE). 
Articles  required. 

1.  Bed  prepared  for  occupancy. 

2.  Subject  (nunse  or  patient). 
8.  Long  rubber  sheet. 

•4.  Two  bath  blankets  or  bath  sheets. 

5.  Two  bath  towels,  one  face  towel. 

6.  Large  basin  or  foot  tub,  and  bath  tlKn-iuoiuctci-. 

7.  Pitcher  of  cold  water. 

8.  Two  large  Turkish  wash  cloths,  or  several  thicknesses  of  gauze. 

9.  Hot  water  bag,  ice  cap,  basin  of  crushed  ice,  or  compress  for  head. 

Procedure, 

Place  bath  blanket  or  sheet  over  patient  and  turn  down  upper  bedding 
to  foot  of  bed.  Place  rubber  sheet  covered  with  second  bath  blanket  or 
sheet  under  patient.  Remove  night  gown,  place  hot  water  bag  at  feet, 
ice  cap,  or  compresses,  on  head.  Cover  upper  edge  of  blanket,  if 
used,  with  hand  towel  to  keep  blanket  from  contact  with  patient  s  mouth 
and  chin.  Temperature  of  water  should  be  as  ordered,  or  60  degrees 
to  70  degrees  Fahrenheit,  and  maintained  throughout  the  bath  by 
adding  ice. 

Begin  by  bathing  the  face  and  neck.  Expose  the  arm  and  place  bath 
towel  lengthwise  under  it.  Wringing  wash  cloth  slightly,  hold  arm  at 
comfortable  angle  and  rub  hand  and  arm  with  rapid  to  and  fro  friction 
movements,  changing  wash  cloth  frequently.  Bathe  other  arm  in  same 
manner,  then  che.st,  abdomen,  thighs,  legs  and  back.  Each  part  should 
be  gone  over  several  times,  the  entire  procedure  occupying  about  twenty 
minutes.  When  finished,  if  necessary,  dry  patient  thoroughly  before 
removing  blankets  or  sheets  and  putting  on  night  gown. 


Commencing  the   cold   sponge. 


50  CALIFORNIA    STATE    BOARD    OF    HEALTH. 

EIGHTEENTH  DEMONSTRATION. 
A   HOT   BLANKET  PACK   (WET). 
Articles   required. 

1.  Bed  prepared  for  oeenpaney. 

2.  Subject  (niir.se  or  patient). 

3.  Five  thick  light,  single  blankets. 

4.  One  hot  water  bag. 

5.  Basin  of  ice  water,  two  gauze  compresses  (1^  yards  gauze  folded 

four  times)  for  head  and  neck. 

6.  One  bath  towel,  one  hand  towel. 

7.  Drinking  glass,  drinking  tube  and  pitcher  of  hot  water. 

8.  Pail  or  foot  tub  filled  with  boiling  water. 

Procedure. 

Cover  patient  with  bath  blanket,  turn  down  upper  bedding  to  foot  of 
bed.  Place  two  single  blankets,  each  one  a  little  more  to  one  side  of  bed, 
or  opposite  side,  under  patient.  Kemove  night  go\^Ti ;  fold  two  bath 
blankets  lengthwise,  then  in  two.  The  process  of  wringing  out  the 
blankets  will  require  two  nurses,  or  where  a  wringer  is  available,  this  can 
be  done  by  one  nurse.  Holding  ends  of  blankets,  immerse  in  boiling 
water  and  wring  by  twi.sting  in  opposite  directions  until  nearly  dry. 
Place  one  blanket  under  patient  as  quickly  as  possible  and  as  soon  as 
temperature  permits,  fold  over  arms  and  legs  so  that  surface  between 
arms  and  body  and  between  thighs  will  not  come  in  contact.  Cover 
patient  with  second  wet  blanket,  then  cover  with  dry  blanket,  turn  up 
blanket  at  side  of  bed,  tucking  over  on  each  side  securely  and  around 
neck.  Protect  chin  from  hot  blankets  by  hand  towel.  Place  hot  water 
bag  at  feet,  wring  compresses  from  ice  water  nearly  dry  and  envelop 
head,  side  of  face  and  neck. 

Cover  patient  with  upper  bedding  or  with  one  thick,  light  blanket. 
Give  hot  drink.  Take  pulse  at  temporal  artery.  Change  cold  com- 
presses frequently,  as  they  get  Avarm,  and  give  plenty  of  fluid  to  drink. 
Patient  to  remain  in  pack  from  twenty  to  thirty  minutes,  or  until  per- 
spiration is  induced,  if  pack  be  borne  well,  or  until  heating  effect  has 
ceased. 

To  take  out  of  pack,  turn  down  upper  bedding,  slip  hands  under 
upper  dry  blanket  and  remove  upper  wet  blanket.  Turn  down  the 
lower  Ijlankets  Avhich  were  folded  over  on  one  side,  remove  lower  wet 
blanket,  dry  with  bath  towel,  remove  lower  dry  blanket,  rub  chest,  arms 
and  legs  vigorously,  put  on  night  gown. 

Note. — Methods  of  giving  this  treatment  to  unconscious,  paralyzed,  or  elderly 
patients,  noting  precautions  to  be  used  to  avoid  burning,  will  be  taught  by  Instructor. 


ELEMENTARY  NITESTNG  T'ROOEDTTRES.  51 

NINETEENTH  DEMONSTRATION. 
A    HOT   BLANKET   PACK    (DRY). 
Articles  required. 

1.  Bed  prepared  for  occupancy. 

2.  Subject  (nurse  or  patient). 

3.  Four  single,  thick,  light  blankets  (warmed). 

4.  Five  hot  water  bags  or  bottles. 

5.  Basin  of  ice  water  with  gauze  compresses  (1^  yards  folded  four 

times). 

6.  One  bath  towel,  one  hand  towel. 

7.  Drinking  gla.ss,  drinking  tube,  pitcher  of  hot  water  or  lemonade. 

Procedure. 

Cover  patient  with  bath  blanket,  turn  down  upper  bedding  to  foot  of 
bed ;  place  two  bath  blankets  under  patient,  same  as  in  wet  pack.  Bring 
up  each  lower  blanket,  fold  over  and  under  each  arm  and  leg,  so  that 
surfaces  of  body  will  not  come  in  contact.  Place  two  hot  water  bags  on 
each  side  and  one  at  feet ;  cover  patient  with  two  remaining  blankets  and 
tuck  in  securely  on  sides  and  around  neck.  Protect  chin  with  soft  hand 
towel.  Place  compresses  on  head,  as  in  wet  pack,  and  change  fre- 
quently. Give  plenty  of  fluid  to  drink.  If  pack  be  well  borne,  allow 
patient  to  remain  twenty  to  thirty  minutes  or  until  perspiration  is 
induced. 

Remove  from  pack  by  taking  away  hot  bottles  first  and  blankets  next 
to  skin,  rubbing  dry  with  bath  towel  as  in  hot  pack. 


52 


CALIFORNIA   STATE   BOARD   OP   HEALTH. 


Hot    dry   pack;    hot   water    bottles    in    place. 


Hot  dry  pack;    patient  enveloped  in  blankets. 


KI,HMi:\''l"Ain'    \ri!SIN(!    riJOf'HDURES.  53 

TWENTIETH   DEMONSTRATION. 
PREPARATION     OF     PATIENT     FOR     SURGICAL     DRESSING,     VAGINAL 

EXAMINATION,   RECTAL   EXAMINATION,  CHEST   EXAMINATION. 
Articles   required. 

Siiroicjil  dressini;' — nhdomiiicil. 

1.  Bed  prepared  for  oeeiipaiicy. 

2.  Subject  (hospital  doll). 

3.  Four  dressing  towels. 

Patient's  head  on  one  or  not  more  than  two  pillows;  upper  bedding 
turned  down  to  thighs  and  night  gown  rolled  well  up  under  arms.  One 
towel  turned  over  top  of  upped  bed  clothes,  one  over  night  gown,  and 
one  on  each  side.  If  gall  bladder  dressing,  one  towel  or  pad  should  be 
placed  under  right  side. 

VAGINAL    EXAMINATION. 
Articles  required. 

1.  Bed  prepared  for  occupancy. 

2.  Subject  (hospital  doll). 

3.  Large  sheet. 

4.  Long  or  obstetrical  stockings. 

5.  Tray  containing 

(a)  Jar  or  tube  of  sterile  vaseline. 

(6)   Speculum,  tenaculum  forceps,  long  uterine  dressing  forceps 

(sterilized). 
(c)   Jar  of  cotton  pledgets. 
(cZ)   Two  dressing  towels,  paper  bag. 

6.  Hot  water,  soap,  brush,  sterile  rubber  gloves  for  doctor. 

Procedure. 

Have  patient  urinate  and,  if  necessary,  give  an  enema.  Wash  vulva 
with  soap  and  water.  Turn  down  upper  bedding,  place  subject  across 
bed,  hips  well  to  edge,  feet  resting  on  two  cliaire,  head  on  one  pillow. 
Put  on  stockings,  drape  sheet  by  giving  a  reverse  twist  in  middle,  place 
one  end  of  dressiiig  towel  under  buttocks  and  turn  other  end  up,  cover- 
ing vulva  until  doctor  is  ready.  Place  tray  of  instruments  where  doctor 
can  reach  easily.  Nurse  stands  on  one  side  of  patient  and  holds  legs 
in  position,  flexed  on  abdomen,  during  the  examination.  After  exam- 
ination, if  necessary,  bathe  vulva,  place  patient  in  bed  comfortably. 

RECTAL    EXAMINATION. 
Articles  required. 

1.  Bed  prepared  for  occupancy. 

2.  Subject  (hospital  doll). 

3.  Large  sheet. 

4.  Long  or  obstetrical  stockings. 

5.  Vaseline. 

6.  Hot  water,  soap,  bru.sh,  sterile  gloves  for  doctor. 


54  CALIFORNIA   STATE   BOARD    OF   HEALTH. 

Procedure. 

If  exaniiiuition  is  to  be  made  with  patient  in  dorsal  position,  place 
in  same  position  as  for  vaginal  examination,  if  on  side,  turn  patient  on 
left  side,  draw  hips  to  edge  of  bed,  tiex  knees,  turn  down  upper  bedding 
to  foot  of  bed.  Cover  with  sheet,  draw  up  night  gown  well  above  hips 
and  place  dressing  towel  under  buttocks. 

CHEST   EXAMINATION    IN    BED. 
Articles  required. 

1.  Bed  prepared. 

2.  Subject  (nurse,  patient  or  hospital  doll). 

3.  Large  square  of  thin  fine  muslin,  steel  tape  line    (centimeter), 

large  soft  pencil. 
■4.  Square  of  flannel  (1  yard). 

Procedure. 

If  female  patient,  remove  hair  ribbons,  pin  hair  neatly  and  closely  to 
head,  or  pin  towel  around  head.  Remove  patient's  gown,  turn  down 
upper  bedding  to  waist  line,  place  flannel  across  chest  until  doctor  is 
ready.  Nurse  stands  on  opposite  side  of  bed  and  assists  doctor  raise 
and  support  patient  when  back  is  examined.  An  auscultating  towel  is 
used  when  doctor  places' his  ear  on  chest  wall.  Dry  well  under  arms 
or  elsewhere,  if  patient  perspires. 

CHEST   EXAMINATION   OUT  OF   BED. 

Remove  all  clothing  to  waist  and  pin  up  hair  neatly  if  female  patient. 
Have  patient  sit  on  a  stool  if  possible.  Tuck  sheet  or  two  hand  towels 
around  clothing  at  waist.  Cover  patient's  shoulders  w^th  flannel 
square,  or  sheet.  Nurse  to  stand  near  patient  to  assist  doctor  and  sup- 
port patient  if  necessary. 


ELEMENTARY  NURSING   I'ROCEDURES. 


55 


Articles   prepared   for   surgical   dressing. 


Patient  prepared  for   dressing. 


56 


CALIFORNIA   STATE   BOARD    OP   HEALTH. 


Patient   prepared   for   vaginal   examination. 


TWENTY-FIRST  DEMONSTRATION. 

FOMENTATIONS  AND  STUPES. 
Articles   required. 

1.  Bed  prepared  for  occupancy. 

2.  Subject  (hospital  doll). 

3.  Four  flannel   fomentation  cloths  sufficiently  large  to  more  than 

cover  part  to  be  treated. 

4.  Fomentation  cover,  of  light  woolen  material,  sufficiently  large  to 

more  than  cover  fomentation  cloth. 

5.  Basin  of  boiling  water. 

6.  Stupe  wringer,  bath  towel,  soft  hand  towel,  small  rubber  sheet. 

7.  Basin  or  tray  to  carry  stupes  to  bedside. 

Procedure. 

Protect  bed  under  part  to  be  treated,  with  rubber  sheet,  covered  with 
bath  towel.  Expose  area,  take  one,  or  if  needed  for  greater  heat,  two, 
fomentation  cloths  put  in  stupe  wringer,  immerse  in  basin  for  one 
minute.  Wring  by  twisting  .sticks  in  opposite  directions  until  water  is 
well  wrung  out.  Carry  to  bedside,  in  basin  or  on  tray  covered  with 
stupe  cover.  Shake  stupes  lightly  and  apply  slowly,  as  patient  can 
bear  the  heat.  If  unbearable  apply  over  a  dry  hand  towel.  Cover  with 
stupe  cover.  Draw  up  bedding  in  place.  Renew  at  least  everj^  five 
minutes  until  time  ordered  for  treatment  has  expired.  To  renew,  pre- 
pare in  same  way  and  do  not  remove  first  fomentation  cloth  until  ready 
to  put  on  second.  Dry  part  with  hand  towel  quickly  before  applying 
second.  Change  should  be  made  rapidly  to  get  effect.  Degrees  of  heat 
may  be  tested  on  back  of  hand.  When  treatment  is  finished,  dry  with 
soft  towel  and  powder  lightl,y. 

Note. — Precautions  against  burning,  especially  in  cases  of  paralysis,  dropsy  or 
unconsciousness,  also  in  very  nervous  and  sensitive  subjects  are  here  emphasized  by 
the  instructor. 


ELEMENTATvY  NURSING  PROCEDURES. 


57 


Articles    prepared    for    application    of    stupe. 


Wringing   stupe. 


58 


CALIFORNLV    STATE    BOARD    OP    HEALTH. 


TWENTY-SECOND  DEMONSTRATION. 
APPLICATION    OF   COLD  COMPRESSES  TO  THROAT. 
Articles  required. 

1.  Subject  (nurse  or  patient). 

2.  Basin  of  ice  water. 

3.  Compress  cloths  of  gauze,  four  to  six  thicknesses,  fourteen  inches 

long. 

4.  Piece  of  tlannel  or  flannelette  16  inches  long,  6  inches  wide. 

5.  Gauze  bandage  three  inches  wide,  small  safety  pins. 

Procedure. 

Wring  compress  cloth  from  ice  water  nearly  dry,  apply  to  throat  and 
neck,  cover  with  flannel  and  pin  securely  in  place  with  three  small 
safety  pins.  Measure  a  length  of  bandage  from  ear  to  ear,  across  top 
of  head.  Split  each  end  about  two  inches  and  fasten  with  safety  pins 
to  upper  edge  of  flannel  on  each  side  of  ear.  This  will  hold  compress 
in  place  and  prevent  sagging.  This  should  be  renewed  frecpiently  if 
cold  is  to  be  maintained  but  it  can  usually  be  kept  on  all  night. 

APPLICATION   OF  COLD  COMPRESS  TO   EYE. 
Articles  required. 

1.  Absorbent  cotton  and  gauze. 

2.  Basin  containing  a  good  sized  piece  of  ice  suspended  in  gauze  or 

a  towel. 

Procedure. 

Compresses  made  of  the  absorbent  cotton  or  gauze  (two  thicknesses) 
and  cut  round  or  oval.  Compress  must  be  very  light,  moistened  and 
placed  on  ice.  These  compresses  must  be  renewed  every  two  minutes 
and  continued  for  length  of  time  ordered  by  doctor. 


Compress   applied    to   throat. 


ELEMENTARY  NURSING  PROCEDURES.  59 

TWENTY-THIRD  DEMONSTRATION. 
LAVAGE. 
Articles  required. 

1.  Stomach  tube  boiled  and  in  basin  of  cold  water. 

2.  Basin  to  receive  stomach  contents. 

3.  Glycerine  in  medicine  glass  to  lubricate  tube. 

4.  Light  weight  rubber  apron. 

5.  Two  towels. 

6.  Foot  tub. 

7.  Pitcher  of  solution,  boric  or  soda,  for  washing  out  stomach. 

8.  Glass  of  drinking  water. 

Procedure. 

If  patient  is  out  of  bed  remove  collar  and  loosen  clothing  at  neck. 
Tie  rubber  apron  around  neck  and  tuck  towel  over  edge  around  neck. 
Patient  to  sit  on  chair,  foot  tub  placed  at  feet  to  receive  washings. 

If  patient  is  in  bed,  move  to  edge  of  bed  toward  operator,  head  and 
shoulders  propped  up  with  pillows ;  place  towel  over  pillows,  tie  rubber 
apron  around  neck,  tuck  towel  over  edge  around  neck.  Make  a  trough 
of  apron  into  foot  tub  beside  bed.  If  foot  tub  is  small,  place  news- 
papers on  floor  under  tub  to  avoid  soiling  floor  or  rug.  Patient  may 
require  a  glass  of  water  after  lavage. 

If  contents  are  to  be  saved,  see  that  basin  is  covered  with  towel  on 
taking  from  room  or  ward  to  laboratory. 


60 


CALIFORNIA    STATE   BOARD   OP   HEALTH. 


Articles  prepared  for  lavage. 


Patient   prepared  for  lavage. 


ELEMENTAEY  KTTRSTN-G  TriOCEDURES.  61 

INSTRUCTOR'S   NOTES. 


62  CALIFORNIA    STATE   BOARD   OP   HEALTH. 

INSTRUCTOR'S   NOTES. 


ELEMENTARY  NURSING   rUOCEDURKS.  63 

INSTRUCTOR'S   NOTES. 


64  CALIFORNIA   STATE   BOARD    OF    HEALTH. 

INSTRUCTOR'S   NOTES. 


:i.i:.mi:n'iai;y  mi.-sinc  iMjocioDrnKS.  65 

INSTRUCTOR'S   NOTES. 


V;     ■'•'I'-. 


?•:■■■■.()■  i'F'-'. 


f'l:;;-^'-*: 


■^M:iK<  :''if.i 


,.>•:,•'<'. 


mm. 


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